Prevalence and correlates of depressive symptoms following traumatic brain injuries in children.

The prevalence and correlates of depressive symptoms following childhood traumatic brain injuries (TBI) were examined using data drawn from a prospective longitudinal study. Participants included 38 children with severe TBI, 51 with moderate TBI, and 55 with orthopedic injuries (OI). Assessments occurred shortly after injury (baseline) and at 6- and 12-month follow-ups. Children completed the Child Depression Inventory (CDI). Parents rated depressive symptoms using the Child Behavior Checklist (CBC), with baseline ratings reflecting premorbid status. Assessments also included measures of children's neurocognitive functioning and the family environment. The three groups did not differ overall in self-reported symptoms on the CDI, but did display different trends over time. The three groups did not differ on parent ratings of premorbid depressive symptoms on the CBC, but parents reported more depressive symptoms in the TBI groups than in the OI group at 6- and 12-month follow-ups. Child and parent reports were correlated for children in the TBI groups, but not for those in the OI group. Depressive symptoms were related to socioeconomic status in all groups. Socioeconomic status also was a significant moderator of group differences, such that the effects of TBI were exacerbated in children from more disadvantaged homes. Although self-reports of depressive symptoms were related inconsistently to children's verbal memory, parent reports of depressive symptoms were unrelated to IQ or verbal memory. The findings suggest that TBI increases the risk of depressive symptoms, especially among more socially disadvantaged children, and that depressive symptoms are not strongly related to post-injury neurocognitive deficits.     

Posttraumatic stress symptoms in children following orthopedic or traumatic brain injury.

Examined posttraumatic stress (PTS) symptoms in children following pediatric traumatic brain injury (TBI). Children (ages 6-12) with TBI (n = 81) and orthopedic injury (OI; n = 59) were assessed 6 and 12 months postinjury. Parents of children with severe TBI reported higher levels of child PTS symptoms than did parents of children with moderate TBI or OI at the 6- and 12-month follow-ups. Group differences in child-reported PTS symptoms emerged at the 12-month follow-up with higher symptom levels reported by children with severe TBI than by those with moderate TBI or OI. At both follow-ups, rates of clinically significant symptom levels were higher in the severe TBI group than in the moderate TBI or OI groups. The group differences in parent and child reports were significant even after taking ethnicity, social disadvantage, and age at injury into account. Parent and child reports of child PTS symptoms were related to family socioeconomic status. Implications for clinical intervention with children and families following pediatric TBI are discussed.     

Agreement between Parents and Children on Ratings of Post-Concussive Symptoms Following Mild Traumatic Brain Injury

The level of parent-child agreement on post-concussive symptoms (PCS) was examined in children following mild traumatic brain injuries (TBI). As part of a larger longitudinal study, 186 children with mild TBI and 99 with orthopedic injuries (OI), from 8 to 15 years of age, were recruited prospectively. Parents and children completed the PCS Interview (PCS-I) and the Health and Behavior Inventory (HBI) at 2 weeks, 1 month, 3 months, and 12 months postinjury. Item-level correlations between child and parent ratings on both measures of PCS were significant but modest in both groups. Parent-child correlations for composite scales on the HBI and the total score on the PCS-I were significant in both groups, but somewhat higher in the OI group than in the mild TBI group. Mean symptom ratings tended to be significantly higher for children as compared to parents, especially for somatic symptoms. Parents and children display modest agreement when reporting PCS; their ratings correlate significantly, but children report higher mean levels of symptoms than parents.     

The relationship of parental warm responsiveness and negativity to emerging behavior problems following traumatic brain injury in young children

Parenting behaviors play a critical role in the child's behavioral development, particularly for children with neurological deficits. This study examined the relationship of parental warm responsiveness and negativity to changes in behavior following traumatic brain injury (TBI) in young children relative to an age-matched cohort of children with orthopedic injuries (OI). It was hypothesized that responsive parenting would buffer the adverse effects of TBI on child behavior, whereas parental negativity would exacerbate these effects. Children, ages 3-7 years, hospitalized for TBI (n = 80) or OI (n = 113), were seen acutely and again 6 months later. Parent-child dyads were videotaped during free play. Parents completed behavior ratings (Child Behavior Checklist; T. M. Achenbach & L. A. Rescorla, 2001) at both visits, with baseline ratings reflecting preinjury behavior. Hypotheses were tested using multiple regression, with preinjury behavior ratings, race, income, child IQ, family functioning, and acute parental distress serving as covariates. Parental responsiveness and negativity had stronger associations with emerging externalizing behaviors and attention-deficit/hyperactivity disorder symptoms among children with severe TBI. Findings suggest that parenting quality may facilitate or impede behavioral recovery following early TBI. Interventions that increase positive parenting may partially ameliorate emerging behavior problems.     

Social Problem-Solving Skills in Children with Traumatic Brain Injury: Long-Term Outcomes and Prediction of Social Competence

The effects of childhood traumatic brain injury (TBI) on social problem-solving were examined in 35 children with severe TBI, 40 children with moderate TBI, and 46 children with orthopedic injuries (OI). The children were recruited prospectively following injuries that occurred between 6 and 12 years of age. They were followed longitudinally, and ranged from 9 to 18 years of age at the time of the current study, which occurred on average 4 years post injury. They were administered a semi-structured interview used in previous research on social problem-solving to assess the developmental level of their responses to hypothetical dilemmas involving social conflict. Children in the severe TBI group defined the social dilemmas and generated alternative strategies to solve those dilemmas at the same developmental level as did children in the OI group. However, they articulated lower-level strategies as the best way to solve the dilemmas and used lower-level reasoning to evaluate the effectiveness of the strategies. After controlling for group membership, race, socioeconomic status, IQ, and age, children's social problem-solving, and particularly the developmental level of their preferred strategies for resolving conflicts, predicted parents ratings of children's social skills, peer relationships, aggressive behavior, and academic performance. The findings indicate that children with severe TBI demonstrate selective, long-term deficits in their social problem-solving skills that may help to account for their poor social and academic outcomes.     

Investigating social functioning after early mild TBI: the quality of parent–child interactions

The young brain is particularly vulnerable to injury due to inherent physiological and developmental factors, and even mild forms of traumatic brain injury (mTBI) can sometimes result in cognitive and behavioural difficulties. Despite the high prevalence of paediatric mTBI, little is known of its impact on children's social functioning. Parent–child relationships represent the centre of young children's social environments and are therefore ideal contexts for studying the potential effects of mTBI on children's social functioning. The aim of this study was to assess the quality of parent–child interactions after mTBI using observational assessment methods and parental report. The sample included 130 children (18–60 months at recruitment) divided into three groups: children with uncomplicated mTBI (n = 47), children with orthopaedic injury (OI, n = 27), and non‐injured children (NI, n = 56). The quality of parent–child interactions was assessed 6 months post‐injury using the Mutually Responsive Orientation (MRO) scale, an observational measure which focuses on the dyadic nature of parent–child exchanges, and the Parental Stress Index questionnaire (Parent‐Child Dysfunctional Interaction (PCDI) domain). Significant differences with medium effect sizes were found between the mTBI group and the NI group on the MRO, but not between the OI group and the other two groups. PCDI scores did not differ across groups, suggesting that observational measures may be more sensitive to changes in parent–child interactions after TBI. The current findings have implications for children's post‐injury social development and highlight the importance of monitoring social outcomes even after minor head injuries.     

Child and parent evaluations of depression and aggression in psychiatric inpatient children

This investigation examined the agreement between children and their parents on measures of depression and aggression. A total of 120 inpatient children (ages 7–13) and their mothers and fathers independently completed self-report and interview measures that focused on the children's dysfunction. Children and their parents differed in their ratings of each symptom area, with children providing significantly less severe ratings than their parents. Children who met DSM III criteria for major depression or conduct disorder were significantly higher in their ratings of depression and aggression than children without these diagnoses, as reflected in both child and parent ratings. Child and parent ratings correlated in the low to moderate range on measures of children's symptoms, whereas mother and father ratings correlated in the moderate to high range. The correspondence between children and parents did not vary as a function of symptom area (depression and aggression) or assessment format (self-report and interviews). The results suggest that children are able to rate the severity of their dysfunction, although they tend to provide lowerbound estimates than do their parents.     

Teachers'' ratings of social competence of children with high versus low levels of depressive symptoms

This study examined the relationship between children's self-ratings of depressive symptoms on the Children's Depression Inventory (CDI) and teachers' ratings of the situational social competence of these children based on the Taxonomy of Problematic Social Situations (TOPS). Children in the high CDI group showed significantly higher teacher ratings (indicating lower social competence) than children in the low CDI group on four TOPS scales: peer group entry, response to provocation, response to success, and teacher expectations. Of the children in the high CDI group, 85% could be correctly classified with a discriminant analysis on the basis of TOPS ratings; of the children in the low CDI group, 77% were correctly classified. Implications of these findings, as well as limitations of the study, are discussed.     

Parental interrater reliability as a function of situational specificity and familiarity of target child

Child behavior ratings were made by 17 mothers and fathers of the same child. Agreement was computed for each parent pair under the following experimental conditions: (1) Ratings of their own child's behavior in general (CBC); (2) ratings of own child based on observations of him/her in a videotaped sample; (3) ratings of an unknown child based on observations of him/her in a videotaped sample; and (4) ratings of the videotaped sample of own child and unknown child using a one minute time-sampling procedure. Parents achieved higher rates of agreement (X=.81) than have previously been reported. Increasing the specificity of the behavior being rated did not significantly affect agreement. Those parent pairs who agreed the most did not necessarily spend a large amount of time in the same kind of situations with their child. Agreement was significantly greater when parents rated their own children's videotaped behavior sample as opposed to that of an unknown child.     

Marital Status,Home Environments,and Family Strain: Complex Effects on Preschool Children's School Readiness Skills

The current study examined the complex associations among marital status, home environments, and family strain (i.e. income, maternal depressive symptoms, social support, and parenting stress), as they predict preschool children's pre‐academic and social skills at 36 and 54 months. Findings from the NICHD Study of Early Child Care and Youth Development (N = 897) showed that the home learning environment, which was significantly lower among single‐parent families, worked as a mediator to explain the relationship between single‐parent families and children's pre‐academic skills at 36 and 54 months. Additionally, parenting stress, which was significantly higher among single‐parent families, worked as a mediator to explain the relationship between single status and the home learning environment. Finally, moderation analyses showed that family income is important for improving the home social environment, and the home social environment is strongly associated with children's social skills in single‐parent families, but not in cohabiting families. Copyright © 2016 John Wiley & Sons, Ltd.     

Predicting toddler anxiety/depressive symptoms: Effects of caregiver sensitivity on temperamentally vulnerable children

This research examines whether maternal sensitivity in early childhood reduces later anxiety/depressive symptoms for children with more temperamental vulnerability, and whether these effects are different for boys and girls. Data from the National Institute of Child Health and Human Development Early Child Care study with 1,226 subjects (631 boys, 595 girls) were analyzed. Mothers and other caregivers rated children's difficult temperament at 1 and 6 months. Trained observers scored maternal sensitivity when children were 6 and 15 months. Child anxiety/depressive symptoms were rated by mothers and other caregivers when children were 2 and 3 years of age. Maternal sensitivity in early childhood significantly predicted decreased 2‐ and 3‐year‐old anxiety/depressive symptoms. Children with more difficult temperament were significantly more likely to show decreased anxiety/depressive symptoms at 2 years of age if their mothers had been more sensitive. Maternal sensitivity also was a significant predictor of decreased anxiety/depressive symptoms for more temperamentally difficult boys, and temperamentally difficult boys with more sensitive mothers were found to be significantly more likely than girls to show decreased anxiety/depressive symptoms at 3 years of age. The findings of this pilot research suggest that facilitating and supporting increased sensitivity for mothers with more temperamentally difficult children could be beneficial. ©2005 Michigan Association for Infant Mental Health.     

Long-Term Executive Function Deficits in Children With Traumatic Brain Injuries: Assessment Using the Behavior Rating Inventory of Executive Function (BRIEF)

Long-term deficits in executive functions following childhood traumatic brain injuries (TBI) were examined using the Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF approximately 5 years postinjury as part of a prospective study of children injured between the ages of 6 and 12. The children were between 10 and 19 years of age at the time of the assessment, and included 33 with severe TBI, 31 with moderate TBI, and 34 with orthopedic injuries. Parents also rated children's adaptive functioning and completed several other measures of parent and family functioning. Children were administered a neuropsychological test battery that included several measures of executive functions. The groups displayed a significant linear trend in BRIEF scores, with the largest deficits in executive functions reported in children with severe TBI. BRIEF scores were related consistently across groups to a test of working memory, but not to other neuropsychological measures. BRIEF scores also predicted children's adaptive functioning and behavioral adjustment, as well as parent psychological distress, perceived family burden, and general family functioning. The findings indicate that TBI results in long-term deficits in executive functions that are related to children's psychosocial outcomes, as well as to parent and family functioning.     

Comorbidity between SCARED anxiety factors and depressive symptomatology in 8- to 12-year-old children

The aim of this study was to examine the comorbidity between the SCARED anxiety factors and depressive symptoms in 8-12-year-old children. Participants were 792 girls and 715 boys, who completed: the 41-ítem version of the Screen for Child Anxiety Related Emotional Disorder (SCARED), the Children's Depression Inventory (CDI) and a Socio-demographic questionnaire. Of the sample, 47% showed anxiety symptoms and 11.5% showed depressive symptoms. Heterotypic comorbidity was 82% in children at risk of depression and 20% in children at risk of anxiety. Homotypic Comorbidity between anxiety factors was 87%. Homotypic comorbidity and heterotypic comorbidity were high; their early detection will prevent the continuity of an anxious disorder and the development of depression.     

Social problem-solving skills in children with traumatic brain injury: long-term outcomes and prediction of social competence.

The effects of childhood traumatic brain injury (TBI) on social problem-solving were examined in 35 children with severe TBI, 40 children with moderate TBI, and 46 children with orthopedic injuries (OI). The children were recruited prospectively following injuries that occurred between 6 and 12 years of age. They were followed longitudinally, and ranged from 9 to 18 years of age at the time of the current study, which occurred on average 4 years post injury. They were administered a semi-structured interview used in previous research on social problem-solving to assess the developmental level of their responses to hypothetical dilemmas involving social conflict. Children in the severe TBI group defined the social dilemmas and generated alternative strategies to solve those dilemmas at the same developmental level as did children in the OI group. However, they articulated lower-level strategies as the best way to solve the dilemmas and used lower-level reasoning to evaluate the effectiveness of the strategies. After controlling for group membership, race, socioeconomic status, IQ, and age, children's social problem-solving, and particularly the developmental level of their preferred strategies for resolving conflicts, predicted parents ratings of children's social skills, peer relationships, aggressive behavior, and academic performance. The findings indicate that children with severe TBI demonstrate selective, long-term deficits in their social problem-solving skills that may help to account for their poor social and academic outcomes.     

Age at injury and long-term behavior problems after traumatic brain injury in young children

Objective: This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI). Method: A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems. Results: At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury. Conclusions: Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Parental ratings of daily behavior and child cognitive test performance after pediatric mild traumatic brain injury

This study aimed to evaluate the degree to which the Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL) measure overlapping vs. distinct constructs in pediatric patients with mild traumatic brain injury (TBI), and to examine the demographic and injury correlates of such constructs as well as those of cognitive test performance. A total of 100 parents completed the BRIEF and the CBCL within 1 to 12 months after the injury of their child. Groups were contrasted based on the presence vs. absence of impairment on, respectively, the BRIEF and the CBCL. Exploratory maximum likelihood factor analysis was used to evaluate latent constructs. Correlates of the various factor scores were evaluated through regression analysis and contrasted with those of a test of verbal learning and memory.The results revealed that the BRIEF and the CBCL disagree about the presence vs. absence of impairment in about one quarter of cases. A prior history of attention deficit/hyperactivity disorder (ADHD) was associated with an increased likelihood of impairment on both the BRIEF and the CBCL, whereas prior outpatient psychiatric treatment was associated with the increased likelihood of selective impairment on the CBCL. Latent constructs manifested themselves along cognitive regulation, emotional adjustment and behavioral regulation factors. Whereas premorbid characteristics were the exclusive correlates of these factors, performance on a test of verbal learning and memory was negatively affected by intracranial lesions on neuroimaging.It is concluded that the BRIEF and the CBCL offer complementary and non-redundant information about daily functioning after pediatric mild TBI. The correlates of cognitive test performance and parental behavior ratings after such injuries are different and reflect a divergence between premorbid and injury-related influences.     

Parents’ postnatal depressive symptoms and their children's academic attainment at 16 years: Pathways of risk transmission

The aim of the study was to examine whether parents’ increased postnatal depressive symptoms predicted children's academic attainment over time and whether the parent–child relationship, children's prior academic attainment, and mental health mediated this association. We conducted secondary analyses on the Avon Longitudinal Study of Parents and Children data (12,607 mothers, 9,456 fathers). Each parent completed the Edinburgh-Postnatal Depression Scale at 8 weeks after the child's birth (predictor) and a questionnaire about the mother–child and father–child relationship at 7 years and 1 month (mediator). The children's mental health problems were assessed with the teacher version of the Strengths and Difficulties Questionnaire at 10–11 years (mediator). We used data on the children's academic attainment on UK Key Stage 1 (5–7 years; mediator) and Key Stage 4 (General Certificate of Secondary Education 16 years) (outcome). We adjusted for the parents’ education, and child gender and cognitive ability. The results revealed that parents’ depressive symptoms at 8 weeks predicted lower academic performance in children at 16 years. Mothers’ postnatal depressive symptoms had an indirect effect through children's mental health problems on academic outcomes at 16 years via negative mother–child relationship, and prior academic attainment. There was a significant negative indirect effect of fathers’ postnatal depressive symptoms on academic attainment at 16 years via negative father–child relationship on child mental health. The findings suggest that the family environment (parental mental health and parent–child relationship) and children's mental health should be potential targets for support programmes for children of depressed parents.     

Moderators of the Relation Between Popularity and Depressive Symptoms in Children: Processing Strength and Friendship Value

Children with low (n = 25) and high (n = 38) peer-rated popularity completed an emotional Stroop task, using negative social words, a self-report measure of friendship value relative to other domains of competence, and the Child Depression Inventory (CDI). Six months later, they completed the CDI again. In regression analyses, after controlling for prior CDI scores, social status interacted significantly with both Stroop and value measures (separate regressions). For unpopular children, both greater friendship valuing and greater negative social word Stroop interference predicted increases in depressive symptoms. In contrast, neither predictor was significant for popular children. In a third regression that included friendship value and Stroop interference as joint predictors of depression change, their effects remained significant and independent. We discuss these findings' implications for 3 models of depression; Champion and Power's social-cognitive theory of depression (L. A. Champion and M. J. Power, 1995), Pyszczynski and Greenberg's self-regulatory perseveration theory of depression (T. Pyszczynski & J. Greenberg, 1992), and Harter's model of global self-worth (S. Harter, 1985).     

Maternal ADHD: Parent-Child Interactions and Relations With Child Disruptive Behavior

This study examined how ADHD symptoms in mothers of children with ADHD relate to their behavior during parent-child interactions and to their children's disruptive behavior. Findings indicated that mothers’ retrospective self-ratings of ADHD symptoms were related to their present negativity during parent-led play. Mothers’ self-ratings of current inattentive symptoms were related to their impatience during child-led play. Maternal ADHD symptoms were also related to their ratings of their children's ADHD and oppositional-defiant behaviors. Identifying relations between maternal psychopathology, such as ADHD symptomatology, and behaviors during parent-child interactions may yield clues to additional parent behavioral changes that would enhance treatment outcomes for young children with ADHD.     

Dyadic Flexibility in Early Parent–Child Interactions: Relations with Maternal Depressive Symptoms and Child Negativity and Behaviour Problems

Lower levels of parent–child affective flexibility indicate risk for children's problem outcomes. This short‐term longitudinal study examined whether maternal depressive symptoms were related to lower levels of dyadic affective flexibility and positive affective content in mother–child problem‐solving interactions at age 3.5 years (N = 100) and whether these maternal and dyadic factors predicted child emotional negativity and behaviour problems at a 4‐month follow‐up. Dyadic flexibility and positive affect were measured using dynamic systems‐based modelling of second‐by‐second affective patterns during a mother–child problem‐solving task. Results showed that higher levels of maternal depressive symptoms were related to lower levels of dyadic affective flexibility, which predicted children's higher levels of negativity and behaviour problems as rated by teachers. Mothers' ratings of child negativity and behaviour problems were predicted by their own depressive symptoms and individual child factors, but not by dyadic flexibility. There were no effects of dyadic positive affect. Findings highlight the importance of studying patterns in real‐time dyadic parent–child interactions as potential mechanisms of risk in developmental psychopathology. Copyright © 2012 John Wiley & Sons, Ltd.